Download Understanding the role of Acute Stress Disorder in

Understanding the role of Acute
Stress Disorder in trauma
Dr. Trina Hall
Police Psychologist
Dallas Police Department
Lessons Learned: Unfolding the story of PTSD
NAMI 2014 Fall Conference
Trauma and Stressor Related disorders
• Acute stress disorder
• Post traumatic stress disorder
Prevalence of Exposure to Traumatic
Events
50%-90% of general population are exposed to
traumatic events during their lifetime.
75% of law enforcement personnel are exposed to
traumatic events in their career.
Most do not develop ASD or PTSD
What is the normal response to a
traumatic event?
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anxiety,
feeling “revved up;”
emotional instability
fatigue
irritability
hyper-vigilance
trouble sleeping
exaggerated startle
response
• change in appetite
• feeling
overwhelmed
• impatience
• isolation from
family and friends
• shock
• nightmares
• somatic complaints
Acute Stress Disorder
• Criterion A: Directly experiencing the
traumatic event
• Criterion B: Presence of at least 9 (or more)of
the following symptoms from any of the 5
categories of: Intrusion, negative mood,
dissociation, avoidance, and arousal,
beginning or worsening after the traumatic
event(s) occurred.
Acute Stress Disorder
• Criterion C: Duration of the disturbance
(symptoms in Criterion B) is 3 days to 1 month
after trauma exposure.
• Looks at emotional reactions to a distressing
event other than looking primarily at fear.
Intrusion
• Recurrent, involuntary, and intrusive
distressing memories of the traumatic event
• Recurrent, distressing dreams of the event
• Dissociative reactions (flashbacks) where
individual feels or acts as if the event were
recurring
• Intense psychological or physiological distress
in response to internal/external cues that
represent aspects of the event
Negative Mood
• Persistent inability to experience positive
emotions
Disassociation
• A subjective
sense of
numbing,
detachment, or
absence of
emotional
responsiveness
• A reduction in
awareness of
his/her
surrounding
Disassociation
• Derealization
• Depersonalization
• Dissociative
amnesia
Avoidance
• Avoids thoughts, feelings, or conversations associated
with the trauma
• Avoids activities, places, or people that arouse
recollection of the trauma
• Inability to recall an important aspect of the trauma
• Feelings of detachment or estrangement from others
Arousal
• Difficulty falling
asleep
• Irritability or
outbursts of anger
• Difficulty
concentrating
• Hypervigilience
• Exaggerated
startle response
Prevalence Rates for ASD
• Identified in less than 20% of cases following
traumatic events that do not involve
interpersonal assault
• Higher rates (20%-50%) are reported following
interpersonal traumatic events, including
assault, rape, and witnessing/involved a
shooting
Prevalence Rates for ASD
• More prevalent in females than males
• Risk factors include: prior mental disorder,
high levels of negative affectivity
(neuroticism), greater perceived severity to
traumatic experience, and avoidant coping
styles.
Initial Assessment
Factors affecting risk of onset of traumaticassociated illness
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Proximity to traumatic event
Similarity to victim (actual versus vicarious experience)
How helpless did the individual feel
Extent of social support will greatly influence prognosis
Exposure to stressors in past 6 months
History and family history of mental illness
Difference between Acute Stress
Disorder and PTSD
• ASD is more immediate, short term response
to trauma.
• ASD is more associated with dissociative
symptoms such as:
– Extreme emotional disconnection
– Difficulty experiencing pleasure
– Temporary or Dissociative Amnesia
Difference between Acute Stress
Disorder and similar disorders
Traumatic Grief
• Sudden unanticipated
loss
• Distressing thoughts
often related to longing
• Duration is a minimum
of 2 months
Difference between Acute Stress
Disorder and similar disorders
Adjustment Disorder
• Identifiable stressor
within 3 months
• Depression, anxiety,
and/or conduct are
primary emotional and
behavioral
characteristics
Treatment of Acute Stress Disorder
• Treatment for acute stress disorder usually
includes a combination of antidepressant
medications and short-term psychotherapy.
• Alternative treatment options include:
– Yoga
– Meditation
Questions
References
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Kessler, R.C., Sonnega, A., Bromet, E. Hughes, M., & Nelson, C.B. (1995). Posttraumatic stress
disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048-1060.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., & Walters, E. E. (2005a). Lifetime prevalence and ageof-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives
of General Psychiatry, 62, 593-602.
Kulka, R.A., Schlenger, W.E., Fairbank, J.A. Hough, R.L., Jordan, B.K., Marmar, C.R., & Weiss, D.S.
(1990). Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam
Veterans Readjustment Study, New York: Brunner/Mazel.
Tanielian, T. & Jaycox, L. (Eds.)(2008). Invisible Wounds of War: Psychological and Cognitive Injuries,
Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation.
www.counseling.org
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th
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Beutler, L. E., Nussbaum, P., & Meredith, K. (1988). Changing personality patterns of police officers.
Professional Psychology: Research and Practice. Vol. 19 (5), 503-507.
Bisson, J. I., McFarlane, A. C., & Rose, S. (2000). Psychological debriefing. In E. F. Foa, T. M. Keane, &
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Bohl, N. (1995). Professionally administered critical incident debriefing for police officers. In M. I.
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